Osteoporosis in Women

What causes osteoporosis and how can prevent and slow down bone loss?

This is the name for the thinning of bones which occurs after the age of 30 years. In both men and women bone mass reduces with age. This decline accelerates in women at the time of the menopause. In addition, women achieve a smaller maximum bone mass at age 30 and then go on to lose bone for a longer period because of their increased longevity over men. Hence the extra risk of fracture to which women are exposed. Many risk factors have been identified in the causation of osteoporosis, including the following:

Aging

Female gender

Premature or artificial menopause

Multiple pregnancies

Family history of osteoporosis and fracture

Ethnic background—black people are better protected

Body build—slim, fair women most at risk

Lack of exercise

Calcium deficient diet

Smoking

Alcohol

Medical treatment, especially steroids and gastric surgery

Other medical conditions, for example overactive thyroid and adrenal glands.

Protection from osteoporosis

A lifelong strategy is required, involving the adoption of a healthy lifestyle; a balanced diet of natural foods, exercise, and the avoidance of detrimental habits, such as smoking and the drinking of alcohol. In this way the maximum bone mass may be initially built up before the age of 30 and then maintained. A threat to bone which can be modified is that caused by the menopause. There is good evidence that hormone replacement therapy (HRT) can prevent the sudden acceleration in bone loss that affects some women. Monthly treatment with oestrogen will slow the natural bone changes. Oestrogen will also offer some protection to some women against heart attacks and will improve the condition of their skin and hair, as well as relieving menopausal symptoms. However, there are potential risks—particularly of cancer of the womb. By supplementing the treatment with progesterone this complication may usually be avoided but there may be a small increased risk of breast cancer. There are several other disadvantages of HRT such as the continued inconvenience of menstrual blood loss and the uncertainty of how long treatment should be undertaken.
Most people would however suggest a course of about ten years, i.e. until the age of about 65 years. It should be realized that HRT cannot replace bone already lost, but can only slow down the loss. Not all women are at equal risk and some selection is therefore needed for those with multiple risk factors.

Bone density can be measured by expensive and non-invasive techniques such as densitometry, and those demonstrating an abnormally rapid bone loss should receive HRT. Unfortunately this investigation is not routinely available through the NHS, but tests can sometimes be arranged through private clinics.